Perioperative immunonutrition in head and neck cancer

• Published in: The Laryngoscope Vol. 119; no. 7; pp. 1358 - 1364
• Main Authors: Sorensen, LTC Douglas, McCarthy, Mary, Baumgartner, MAJ Brian, Demars, CPT Sean
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-07-2009; Wiley-Blackwell
• Subjects: Aged; Analysis of Variance; Biological and medical sciences; Carcinoma, Squamous Cell - immunology; Carcinoma, Squamous Cell - surgery; Female; Food, Formulated; head and neck cancer; Head and Neck Neoplasms - immunology; Head and Neck Neoplasms - surgery; Humans; Immune-modulating nutrition; Male; Medical sciences; Middle Aged; Nutritional Status - immunology; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Postoperative Period; Prospective Studies; Treatment Outcome; Tumors; Wound Healing - drug effects; Nutrition; ENT disease; Head and neck cancer; ENT; Malignant tumor; Immune-modulating nutrition; Cancer; Feeding
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.20494

Objectives/Hypothesis:
Immune‐modulating nutrition (IMN) support before and after surgery has the potential to promote host defense, antitumor activities, and wound healing. The purpose of this study was to examine the nutritional, immunologic, and wound healing outcomes in patients receiving IMN versus standard formula.
Study Design:
A prospective, blinded, randomized design was used for this study. Fifteen patients with head and neck squamous cell carcinoma received either an IMN formula (treatment group) or a standard stress formula (relative comparison group [RCG]) for a period of 7 days pre‐ and postoperatively.
Methods:
Albumin and prealbumin were measured at baseline, day of surgery (DOS), and postoperative day (POD) 1, 4, and 8. Immunologic outcomes included C‐reactive protein and total lymphocyte count with lymphocyte subset counts (CD3, CD4, CD8, CD4:8 ratio, CD19, CD56) at baseline, DOS, POD1, 4, and 8. Cell‐mediated immunity was evaluated by delayed‐type hypersensitivity. Wound healing was assessed using the ASEPSIS tool.
Results:
CD3+ and CD4+ T cells demonstrated a significant difference between groups on POD 1 (P = .03 for both) and CD56 NK cells on POD 8 (P = .04). In general, wounds healed without complications except for tracheoesophageal fistula development in two patients in the RCG.
Conclusions:
A trend toward less immune suppression in patients receiving IMN is supported in this study. Laryngoscope, 2009